The "P" is for Purgatory (or Pain)

I've written some "getting through Parker"-themed entries before, but this deserves its own post (or several), because clinic is its own beast. If you're in Tri 6 or above or you're close to someone who is, you know what I'm talking about. When our class had just started outpatient clinic and we dared to compare notes with each other, I quickly realized that as alone, awkward, incompetent, and overwhelmed as I felt, I was actually not alone. In fact, more people had parallel experiences than not--many more than I ever imagined. As I progressed through clinic into the top tri's, I found myself giving pep-talks to the under-tri's--the same ass-saving words of adviced I had received from senior tri students just a few months before--in an effort to introduce some peace and comfort into the prevailing vibe of anxiety and desperation. And when I started making half-joking noises about writing an unofficial, unauthorized Parker Clinic Survival Guide of sorts, I actually got a lot of encouragement, and they were serious. So, here it is...

The first thing to keep in mind is a very simple concept: they want everyone to have to spend an extra trimester there. No, you're not imagining things. With tuition on the automatic increase every January, it seems as though December graduate-hopefuls are under just a bit larger of a microscope when it comes to scruitinizing credits, and the Axe of No Credit seems to swing just a bit easier in the house's favor. Or so I've been told. Understand and accept that everything you do has to be waterproof and airtight, because they will nullify the entire superbill, and all of its accompanying credit, on a simple technicality, even if that technicality had no impact on either patient care or the school's revenue. Understand that there is indeed a motive hard at work here, penetrating and motivating every decision made. If, despite all of the speedbumps and roadblocks, you're rocking and rolling your way through your requirements, you'd best keep it on the down-low, because if too many people do this, admin will indeed add another hoop for you to jump through, and chances are you won't be grandfathered in.

Now, that's the administration. Enter the attending staff/faculty doctors that oversee and approve what you're doing. They are usually on Team You, at least to some extent. They want you to succeed. They want you to meet your numbers. Their job depends on it; your numbers are their numbers. Part of their salary is based on the productivity of their interns. (Kinda adds validity to the conspiracy theory; if you're not able to adequately meet your numbers, they extract another trimester's worth of full tuition from you, and they need not pay your doc as much. What about the extra revenue they'd generate from patients if the clinic is nice and busy, you ask? Ha. PALE, in comparison to your tuition. Think a patient will ever end up paying $9200 worth of care in 4 months?) So anyway, the staff docs want to see you make it. They want to mould you in their image. Well, some of them do. They all have their reasons for being there, as opposed to real world practice; some, like mine, burned out of uber-successful megapractices, while others couldn't hack private practice and also couldn't admit as much, and came running back to their alma mater. The latter category could give two shits about your success; they're just happy not to be bagging groceries for 8 bucks an hour. But as for the good staff docs, pick their brains. Have them show you some of their tricks of the trade. As far as numbers go, while they can't wave any magic wands and make patients appear out of thin air, they just might could pull you a few strings come crunch time. So keep them in your back pocket.

Now that we know the players, let's set the scene. Opening Act, Tri 7. There are no two ways about it: Tri 7 is an emotional beating. Rationally, it shouldn't be, because the pressure cooker classes are starting to open the release valve, and you're out of Student Clinic (thank God). You can now treat real people and start etching your groove, laying down the foundation you will draw from, quite possibly for the rest of your career.

But in Tri 7, you're missing a very critical component in making that dream come true: patients. Make no mistake, they're scarce, and you're generally on your own, at least for now. If you're going to get any numbers at all this Tri, it's because you made it happen. (Hint: spend as much time as possible in your pod, in front of your staff doctor.) Nobody else is helping you out or holding your hand, and you're going to feel largely ignored and passed over. As hard as it is not to worry, don't. I know, it's easier said than done, but seriously, everybody around you is going through the same thing.

Don't feel shortchanged by your brethren who brag about hitting the ground running with five appointments scheduled the first week. I've personally seen natural law do funny things, like five appointments become zero. So, don't count any chickens before they hatch, because it ain't truly over until all is said and done, and even once it is, don't go bragging about it. On the flipside, don't freak out when you realize that Tri 7 is almost done and you don't even have 20 adjustments yet. Don't start doing the math at this point and wake up clenching your teeth because at this rate, you're only going to have 60 adjustments by graduation, which is less than half of the 200 needed to graduate. If you remember the fairy tale about the Tortoise & the Hare, good, because I see it alive and well every day, and it'll help you to keep it in mind. If you're not familiar with it or you've forgotten, look it up. You'll be glad you did.

Tri 8 gets better. At the tail end of Tri 7, you may (or may not) have been thrown a few bones (i.e. upper tri students pass hand-me-down patients to you). Keep in mind that many of those patients were personal friends of the previous intern who may have been under care for the sole purpose of helping that intern through school, and now that the intern is done, the patients may not have any intention of continuing care. A few transfer patients, however, may decide to come in for you; most of those have already been patients forever. The more time you spend in the pod around your staff doc and upper tri interns, the better your chances of scoring transfer patients. Any help you get by way of patients will probably come from other interns and not your staff doc; in fact, you'll probably wonder when you'll start to get any help and you'll feel like people all around you--even those in your class--are passing you up. My own experience was similar to what I'd heard from others; I didn't hit my stride until the latter part of Tri 8. That's when I finally discovered there was light at the end of the tunnel.

Don't be surprised if you still feel incompetent. Some things will start to come together for you (particularly if you're an experience-based, hands-on learner), like paperwork, clinic procedures, diagnosis and differential diagnosis, and some of the common "chiro" conditions like whiplash and degenerative disc disease. Life in general gets smoother because you really start to feel the tapering off of the academic classes and you now have morning and noon availability that you didn't have before.

Tri 9, in a way, is cake--at least compared to the other tri's. Classes have now disappeared completely off your radar and they fade into the rearview mirror surprisingly quickly. Your evenings become yours again, for the first time in 3 years or so, as you now only have one task: get through clinic. That's it. You treat patients, do your paperwork, and then you get to go home and actively choose what you want to do with the rest of your evening. Now, I have to warn you--there is more to clinic in Tri 9 than there ever was before this. With nearly carte blanche autonomy over your own schedule, you can now see patients any time, and you'll get the bulk of your numbers this tri. So again, don't sweat it if you're coming into Tri 9 with a light tally sheet--here's your chance to shine. Don't forget about rad rotation, arbitrarily inserted into your requirements just when you need that time the most for other things, but alas. And of course, there is always paperwork. But everything else is behind you, you're starting to gain solid ground, and it's a nice feeling. And before you know it...